Image courtesy of Gallup.

More Americans delayed medical treatment in 2022 because of high costs, according to a Gallup poll in which 38% of respondents reported that they or a family member had done so, an increase from 26% in 2021. The 2022 percentage is the highest since Gallup began tracking the issue 22 years ago.

The percentage of adults delaying care for serious medical conditions also jumped, from 18% in 2021 to 27% in 2022—more than twice that for nonserious issues (11%). People in the lowest household income group (earning less than $40,000 a year) were most likely to delay care, with 34% of people reporting they did so. People with household incomes from $40,000 to $100,000 also said they found it hard to afford needed care; 29% reported delaying care. Adults ages 18 to 49 years had higher rates of delayed care than older adults (35% versus 13%, respectively), and women had significantly higher rates than men (32% versus 20%, respectively). An influencing factor, according to the pollsters, was high inflation during 2022, which strained household budgets.

Consumer debt is another measure of the burden of health care costs in the United States. Medical collections make up the largest portion—57%—of all collections on consumer credit reports, affecting 37.7 million people. According to a report from the Urban Institute, close to three-quarters of people with past-due medical debt owed at least some of it to hospitals. And, the report notes, people with overdue hospital bills usually have much higher overall debt than those who only owe money to nonhospital health care providers. A Kaiser Family Foundation survey last summer found that to pay down medical debt, people cut spending on food and clothing, dipped into savings and retirement plans, and took on more work. Some lost homes or were forced into bankruptcy.

There is some good news. According to the U.S. Consumer Financial Protection Bureau, 8.2 million fewer people had medical debt on their credit reports in 2022, a drop of 18% since 2020. Also, the major credit rating agencies have changed how medical debt affects credit scores: debts under $500 are no longer reported, and people have one year instead of six months to repay debts over $500 before they become part of an individual's credit report. Finally, a recent push to have hospitals provide higher levels of charity care may alleviate some financial pain for low-income patients. After multiple reports of nonprofit hospitals stinting on the amount of free care required for tax breaks and using aggressive measures, including suing patients, to collect on overdue bills, state governments have moved to expand charity care requirements and hold the hospitals accountable.—Karen Roush, PhD, RN, FNP-BC, news director